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(SHADEDAR TO BE 'FILLWuf41'1r;"*-C JJ46eECTIUN <br /> ED IN FOR THE T TANK ONLY) <br /> G OWNER E OWNER PHONE # / ' <br /> N CONTRACTO CON. PHONE# G <br /> R i SJLHD PERMIT # EPA # <br /> A FIRE PERMIT # <br /> L <br /> INSPECTOR 4 "S DATE q/27 ,�Py TANK # 39 - - <br /> R RINSED (Y N) METHOD 7' RINSE AMO <br /> I !1' <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD AMOUNT USED <br /> A <br /> . P L.E.L. READING AT REMOVAL (MUST B < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> PN TANK CONDITION (GOOD, POOR, HOLES) •/ % <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) K� # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N � t — <br /> E K <br /> L <br /> D EXCAVATION SIZE: X � X YDS OF SOIL: <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: S NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EII 23 043(7/88) DRAW SITE MAP ON REVERSE <br />